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Recurrent bleeding continues to drive adverse outcomes after peptic ulcer hemorrhage, underscoring the potential role of adjunctive embolization therapy.
Successful endoscopic control of peptic ulcer bleeding does not eliminate the risk of recurrent hemorrhage, which remains a frequent cause of complications and prolonged hospitalization. As clinicians seek strategies to reduce this risk, researchers examined the incidence, predictors, and consequences of rebleeding while evaluating the potential contribution of prophylactic transarterial embolization (pTAE) to patient outcomes.
To better understand post-hemostasis outcomes, investigators evaluated patients treated for peptic ulcer bleeding at a Danish University Hospital over a four-year period. Clinical follow-up extended to one year, enabling assessment of recurrent bleeding, associated complications, and mortality. Patients with high-risk ulcer characteristics were analyzed as a distinct subgroup, while the role of pTAE was explored as a potential strategy to mitigate adverse outcomes.
Among 174 patients treated for peptic ulcer bleeding, recurrent hemorrhage remained a frequent complication despite successful endoscopic hemostasis, with 28% experiencing rebleeding during follow-up. Key findings include:
Rebleeding was significantly associated with:
Patients with rebleeding experienced:
The predefined high-risk subgroup demonstrated:
Among the 10 patients (6%) who underwent pTAE following initial successful endoscopic hemostasis, rebleeding and mortality rates were similar to those observed in patients who did not receive pTAE. However, a more favorable signal emerged among patients who rebled. Of the 49 subjects with rebleeding, approximately 25% underwent pTAE following a second successful endoscopic intervention.
In this subgroup, one-year mortality was lower in patients receiving pTAE compared with those who did not (17% vs. 43%). The results highlighted recurrent bleeding as a persistent challenge after endoscopic hemostasis, particularly among patients with high-risk ulcer characteristics.
Scandinavian Journal of Gastroenterology
Peptic ulcer bleeding and use of transarterial embolization at a center without on-site interventional radiologists: a retrospective cohort study
Maria Vestergaard Jensen et al.
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